SU0004499 SSNL - Laserfiche WebLink

Home Browse Search

l FOR OFFICE USE- Y APPLICATION FOR SANITATION PEi,.,,IT ------------------------------------------------- (Complete in Triplicate) Permit No`. -----(--------------- _ _________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued __LZ_ ?0_� � __ _ _ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ^` -- ---- t'" `x='------------- -- --------CENSUS TRACT =x _..------•--------- JOB ADDRESS/LOCATION .__1 �_l`._'____-__._ __ _ -'�-�'_ Owner's Name ._- r� -- F----- ------ --- - - -------.. ._Phone _. r + 7 Mr Address ------------------f �. - ~ " City -- ' - -- ------------------------------ Contractor's Name -------- --------------------------------License # --------- -------------- Phone - ------------------------- j Installation will serve: Residence ® Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:____________ Number of bedrooms ___________Garbage Grinder ___________ Lot Size _ ds= '_- �— Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------ PrivateE] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam C ! ; Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK;[ ] Size------------------------------------------------ Liquid Depth -------------------------- t/ j Capacity ------ ------------- Type -------------------- Material---------------------- No. Compartments -------•-------------- 1i Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------------_- A LEACHING LINE [ ] No. of Lines ------------------------ Length of each line___________________________ Total Length ------_____,________________ F� 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------- --------_------------- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _____-__--___-_-__ SEEPAGE PIT Depth -------------------- Diameter ________________ Number --------------------------- Rock Filled Yes '❑ No i❑ Water Table Depth ----------------------------- -------••.........Rock Size ---------------------- Distance to nearest: Well -------------------------- -- Foundation --------------- ---- Prop. Line _-------------------- . REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ----------------------------------) i w Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------------- - Disposal Field (Specify Requirements) --- �- --------- - - - -A '==�r V "-��-- `vim__________________ __ _____.__v------------------------------------------------------------------------------------------------------------------------------------------ .________________________ f ---------------------- -----------------------------------------------------------------------------`--------------------------""----------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin u County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: t "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner g to to Workman's Compensation laws of California." Signe ned -- I_ -- ----------------- Owner ------------------------------------- ---- -:�T- ,T l SY ------------------------------------------ Title ---------------------- (If other than owner) FOR DEPARTMENT USE ONLY P ` APPLICATION ACCEPTED BY ....... - - -"_ ------- - --------------------------- -------------- - ----- DATE �_.�`".---� - -- - -- - ----- BUILDING PERMIT ISSUED --------------------------------------------- - -------DATE ---------------------------------------•--- ADDITIONALCOMMENTS --------------------------------------------------------•- •---•-•------------ ------------------------------------------- -------=-------------- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------- � - r- ' a - Final Inspection by: Datef r ; SAN JOAQUIN LOCAL HEALTH DISTRICT